Schramme: Tristram Engelhardt & Edmund Erde’s philosophy of medicine

Tristram Engelhardt and Edmund Erde coauthored an entry on “Philosophy of Medicine” for the 1978 edition of the influential Encyclopedia of Bioethics and later published another substantial article on the subject (Engelhardt and Erde 1980). Similarly to Pellegrino, they also distinguish between different types of relationships between philosophy and medicine:

Philosophical activity concerning medicine can be focused through four major themes: Philosophy for medicine, philosophy in medicine, philosophy about medicine, and philosophy of medicine. (…) The first uses concepts speculatively to generate medical explanations. (…) The second theme can be styled ‘philosophy in medicine’. Here, philosophy is a formal analytical tool, not in the direct service of medical theory or therapy, but rather employed to display logical structures in medicine. (…) The third theme (…) involves reflection on traditional philosophical issues (not logical issues in the strict sense) arising from the domain of medicine. (…) The fourth theme, ‘philosophy of medicine’, can be used to identify those epistemological and conceptual issues peculiar to medicine in a way analogous to the philosophy of any science (…). (Engelhardt and Erde 1978, 1049 f.)

Surely, this classification of various relations between medicine and philosophy cannot simply be taken to be descriptive. Engelhardt and Erde hence regard their definition of the philosophy of medicine to be the proper one. Here, they endorse a fairly narrow understanding of philosophy of medicine that they later gave up, because they appreciated that the field of “medicine” cannot easily be delineated. Still, in the quoted definition, they exclude bioethics from the realm of philosophy of medicine, like Pellegrino. Bioethics belongs to the category of “philosophy about medicine,” because its problems are traditional ones, not specific to medicine, if raised here in a new way. Other problems of philosophy about medicine have also been introduced in other domains, such as philosophy of mind and philosophy of science, and then been applied to medicine. In contrast to such transfer of philosophical issues to medicine, philosophy of medicine deals with problems specific to medicine, according to Engelhardt and Erde. Examples are the analysis of basic medical concepts, such as “disease,” “pathology,” or “health.” Engelhardt, at [11] another occasion, calls this subject area of study philosophy of medicine in a strong sense (Engelhardt (1977), 98 ff.). According to this understanding, “philosophy about medicine” would be equal to “philosophy of medicine” in a weak sense.